We can learn from the world's largest electronic payment messaging system to set up the right global health infrastructure to respond to Covid-19.
UNTIL a Covid-19 vaccine is available, the world needs a health information system to restart free and safe international travel.
What might this Covid-19-free travel infrastructure look like, what lessons can we learn from the Swift financial messaging system, and how to and who should implement such a global health system?
Swift – which stands for Society for Worldwide Interbank Financial Telecommunication – is the world's largest electronic payment messaging system. What has a finance system got to do with trace-tracking Covid-19, one might wonder.
A clue lies in what it actually does – it is a cooperative network set up by banks worldwide to transmit information about financial transactions in a secure way.
Frameworks on Covid-19-free travel currently revolve around immunity passports, and travel corridors or "travel bubbles".
Whatever the case, all options for safe travel must be underpinned by a truly global infrastructure with several fundamental features.
First, the infrastructure must enable accurate, verifiable and tamper-proof exchange of relevant health information – such as the dates, methods and results of Covid-19 tests for travellers.
It must be interoperable between the public health, laboratory and disease surveillance systems of different countries, while operating in a decentralised fashion with a robust business continuity plan.
Second, it must have adequate (but not perfect) regulatory harmonisation between the public health, medical devices, pathology laboratories and immigration regulators of all countries, with mutual recognition of adequate testing standards and protocols.
Third, this infrastructure must be considered a global public good, which means it must be inclusive – highly accessible and governed by as many stakeholders as possible – and responsive, with agile decision-making during a pandemic with rapidly evolving science.
Let's call it the Covid-19-free and Healthy International Travel System, or Chits. This should provide a secure and verifiable digital identity for travellers tied to a trusted Covid-19 status. Let's call this the Chit Code, a time-limited unique identifier that is an epidemiologic lingua franca accepted globally.
The Chit Code is one piece of the jigsaw puzzle of safe international travel, with other pieces being movement tracker apps, travel insurance and pre-approved itineraries.
Fortunately, there is a successful model for Chits to follow. Launched in 1977 and headquartered in Belgium, the Swift system provides efficient and reliable plumbing for the gargantuan international financial system. Today, it covers over 200 countries and 11,000 financial institutions, with a whopping 38 million daily transactions.
Swift took four years to build, but Chits must and can be built faster.
This speed can be achieved by building on the existing Swift operating model and incorporating relevant non-Swift technologies such as blockchain, electronic health records (EHR) and digital identity management.
There are three additional unique features of Swift that can be borrowed by Chits.
One, a cooperative model jointly owned by national regulators and public and private healthcare service providers is the fastest, most agile and least imperfect governance and operating model. Governing the global health commons is difficult, but there is a space for private provision and stewardship of public goods with reasonable profit-making.
Two, Chits must act as a de facto standard-setting international agency and be laid over the public health and laboratory infrastructure of countries.
Barriers to entry must be appropriately high without worsening health and systemic inequalities. Chits must encourage competition on price, speed, accessibility and convenience of tests, while meeting the moral burden of testing quality and accuracy.
Three, Chits can provide additional tools beyond identity management and Covid-19 status. Anti-fraud and compliance can be built into Chits using a Big Data approach.
Aggregated, anonymised and real-time testing or movement data can be shared with epidemiologists, regulators and researchers, or appropriately shared with private entities. These can provide Chits with an additional income stream on top of subscriptions or transaction fees.
There are three steps to implementing Chits.
The primary ingredient is a consortium of non-state entities willing and able to underwrite the initial investment and infrastructure-building.
Governments can provide initial leadership, but must be backed up by global health organisations, foundations, philanthropies and the private sector. Notable private industries include Big Tech, digital health, EHR companies, financial services and logistics.
Although the United Nations, supranational entities such as the European Union or regional entities like Asean or the Economic Community of West African States would be ideal, they are not well placed to launch and govern Chits with the speed and effectiveness that the world needs.
Their bureaucracy, veto politics, pre-existing priorities and lack of capacity hamstring their abilities. Conversely, the pre-existing global infrastructure of private sector actors is an advantage as it also resolves dilemmas about nationalism, sovereignty and pride.
Such a public-private consortium must then implement transparent self-regulation based on stringent scientific and public health principles.
Finally, Chits must be open-source and democratised, with a robust protocol to detect and address fraud and mistakes.
Chits is necessary for reopening borders, but insufficient. Frameworks to ensure accuracy, verifiability and speed are crucial pieces of the overall solution for safe travels in the Covid-19 era.
The global health infrastructure that we build in response to Covid-19 will define the 2020s. This pandemic will not be humanity's last, so there are good reasons to invest time, energy, money, ambition and imagination into building a Chits-like system for long-term use. — The Straits Times/Asia News Network
Dr Khor Swee Kheng is a physician specialising in health systems, health policies and global health.
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